Definition
It is an operative procedure whereby the fetus is delivered after the 28th week through an incision on the abdominal and uterine walls.
Indication of caesarian section
A. Absolute indications
B. Relative indications
Common indication of emergency C/S
Complication of caesarian section
A. Maternal complications
B. Fetal complication
Management of C/S / Steps of LUCS
Intra-operative procedures
i. Position- supine position.
ii. Anaesthesia: Spinal anesthesia, general anaesthesia, epidural anaesthesia.
iii. Anti-septic wash- mid chest to mid thigh region including vulva and vagina by 10% chlorohexidin solution.
iv. Draping.
v. Proper light.
vi. Incision: Pfennesteil incision is made commonly 3cm above the symphysis pubis.
• Skin, Superficial fascia, the recti and pyramidalis muscles are retracted laterally from the midline.
• A short incision is made in the midline down to the membranes.
• The incision of the lower segment is being enlarged using index finger of both hands.
vii. Delivery of the head.
viii. Delivery of the trunk.
ix. Removal of placenta and membrane by CCT.
x. Securing the bleeding vessels properly.
xi. Suture of the uterine wound.
xii. Closure:
• Peritonium: continuous suture with chromic 1 or 2 catgut in a rounded bodies needle.
• Anterior rectus sheath: continuous suture with chromic 1 or 2 catgut in a cutting bodies needle.
• Subcutaneous tissue: interrupted stich with plain catgut.
• Skin: interrupted silk stitch or subcutaneous (cosmetic purpose).
Post operative procedures
‘0’ POD
i. Follow the post operative order-
• NPO till further order
• Inf. 5% DNS (2l)+Inj.Oxytocin (2 amp in each litre of fluid) I/ V @ 30 drops/min.
• Inj. Ceftriaxone (1gm) 1 vial I/V stat and daily.
• Inj. Metronidazole (500mg) 1 bottle I/V stat and daily.
• Inj. Pethidine (100mg) 1 ample I/M stat and SOS.
• Inj. Metoclopramide (12.5 mg) 1 amp I/M stat and SOS.
• Inj. Tramadol (100 mg) 1 amp I/M 12 hourly.
• Inj. Ranitidine (50 mg) 1 amp I/V stat and 8 hourly.
• Diclofenac suppositories (50 mg) 1 stick per-rectally SOS.
• Continue catheter for 3 days ( if obstructed labor the 21 days).
• Change posture at two hours interval.
• Monitor vital signs routinely.
ii. Effective pain management.
iii. Examination of the dressing.
iv. Routine vital signs monitoring.
v. Urine output monitoring.
vi. Auscultation of abdomen for bowel sound.
1st POD
i. I/V fluid continue with sips of water orally.
ii. Early mobilization.
iii. Checking the bandage.
iv. Monitor vital signs.
2nd POD
i. If bowel sound present then liquid diet followed by semisolid food.
ii. I/V fluid reduce to 1 liter.
iii. Antibiotic in oral from.
iv. Catheter should be clamped.
v. Mobilization continue.
vi. Monitor vital signs.
3rd POD
i. If no problem then diet is regular high protein and high fiber diet.
ii. I/V fluid withdrawn.
iii. Catheter withdrawn.
iv. Checking bandage.
v. Monitor vital signs.
4th POD
i. Dressing is done.
ii. Monitor vital signs.
5th POD
i. Continue the same
6th POD
i. If wound is healthy alternate stich may be off.
ii. Continue the same.
7th POD
i. Complete removal of stitch.
ii. Discharge the patient with advice-
• Diet- High nutritious diet containing high class protein, vitamins, minerals, fiber etc.
• Breast feeding
